The four specialist PRA routes at a glance
Tap a province for its full requirements and application steps.
| Province | Exam | Job offer | Practice and training | Assessment | Also note |
|---|---|---|---|---|---|
| AB Alberta | Registration exam: the MCCQE | Required; sponsored jobs on DoctorJobsAlberta.com | At least 1 year of practice or training in the specialty within the last 3 years; training equivalent to Royal College standards, with specialist certification | Two parts of 12 weeks each, passed in succession | Start with a CPSA eligibility letter |
| MB Manitoba | MCCQE not required | Approved sponsor and a job offer in a high-need specialty (the Health Care Retention and Recruitment Office job board) | Recent and relevant clinical practice | Minimum three months | Applications expire six months after they are received |
| QC Quebec | MCCQE | Sponsorship through Recrutement Santé Québec (RSQ) | 12 months in your area during the 3 years before applying; training generally equivalent to Quebec’s (4 to 6 years) | 12 weeks, preceded by a week of observation | French proficiency required; restrictive permit; 9 to 18 months on average |
| NS Nova Scotia | No exam listed in the CPSNS policy | Required, with Nova Scotia Health or the IWK Health Centre; plus Department of Health and Wellness funding tied to a return of service | Specialty training equivalent to the Canadian program, specialty certification where you trained, and currency of practice under the CPSNS policy | 8-week framework; at least 75% away from the intended site of practice | Rarely used: no intake to apply to, only a Nova Scotia Health or IWK job offer; ineligible after two or more unsuccessful Canadian PRA attempts; the health authority selects among eligible candidates |
- Job offer: required in all four provinces. A specialist PRA runs inside a real position.
- Return of service: common. Quebec commits you to three years; Nova Scotia and Manitoba tie it to your funding or sponsorship agreement without publishing a length. Read the contract.
Four provinces run a Practice-Ready Assessment route for internationally trained specialists: Alberta, Manitoba, Quebec, and Nova Scotia. This guide covers each one, in the order used in the source e-book.
How this relates to the PER. The Practice Eligibility Route (PER) leads to certification by the Royal College of Physicians and Surgeons of Canada and is covered in the Interactive PER Guide. A provincial Practice-Ready Assessment for specialists is a separate, province-run route to a licence, and Nova Scotia's program is for specialists who completed their specialty training outside Canada. Supervised practice roles for specialists, and the family medicine programs, are covered in the Physician Licensing in Canada interactive guide.
- Exam
- A registration exam: the MCCQEAn approved jurisdiction may also qualify, as approved by the Registrar.
- Job offer
- Required: an eligible sponsorship job on DoctorJobsAlberta.comYour sponsor sends CPSA a sponsorship form. See Alberta jobs that are sponsorship eligible
- Practice
- At least 1 year of recent practice or postgraduate training in the intended specialty, within the last 3 years
- Training
- All postgraduate training required for your discipline, equivalent to Royal College (RCPSC) standards, with specialist certification
- Assessment
- Two parts, passed in succession: Part A, preliminary clinical assessment (12 weeks); Part B, probationary assessment (12 weeks)Passing leads to CPSA's temporary Provisional Register.
- Also required
- A medical degree from a school in the World Directory of Medical Schools; criminal record checks; Patient Relations education
- Steps
- Submit a review of qualifications. CPSA confirms whether you meet the requirements and sends an eligibility letter.
- Secure sponsorship through an eligible job on DoctorJobsAlberta.com.
- Submit all supporting documents once CPSA has your sponsorship form.
Official wording (from the college)
“A Practice Readiness Assessment (PRA) is the required final step of an alternate path to independent practice in Alberta for international medical graduates (IMGs) from outside CPSA’s list of approved jurisdictions, and Canadian graduates who fail a national exam.
Once registered with the College of Physicians and Surgeons of Alberta (CPSA), the candidate must pass this 2-part assessment of their clinical competence, chart management and professionalism to join CPSA’s temporary Provisional Register.
The PRA is composed of two parts that applicants must pass in succession before receiving an Alberta medical practice permit:
- Part A: Preliminary clinical assessment (PCA): 12 weeks
- Part B: Probationary assessment (PA): 12 weeks
Eligibility requirements
- Medical degree from a school listed in the World Directory of Medical Schools
- Successful completion of a Registration Exam: a nationally recognized standardized examination in Canada (MCCQE) or an Approved Jurisdiction as approved by the Registrar, which evaluates the medical knowledge, clinical skills, and professional competencies required to practice medicine in Canada. The complete United States Medical Licensing Examination (USMLE) is accepted as an equivalent to the MCCQE. A partial USMLE is not accepted.
- At least 1 year of recent practice or postgraduate training in intended specialty (within the last 3 years).
- Completion of all postgraduate training required for your discipline:
- Discipline specific specialty training equivalent to the Royal College of Physicians and Surgeons of Canada (RCPSC) standards, with specialist certification.
- A criminal record check or police certificate is required from all locations you have practised and/or trained for more than 90 days in the last five years. Canadian criminal record checks are nation-wide, so only one is required. Although we don’t need it, we will accept a vulnerable sector check if it is a part of your criminal record check. In Canada, criminal record checks must be obtained through the RCMP or local police services. Any third-party or online criminal record checks (or police certificates) will not be accepted.
- Patient Relations education is required under the Health Professions Act (HPA) and mandatory for CPSA registration. Applicants are provided with a link to complete this training at the applicable stage.
Application process. Steps to take before you start your PRA:
- Submit review of qualifications and receive eligibility letter. CPSA will confirm if you meet eligibility requirements and send an eligibility letter.
- Secure sponsorship: Apply for eligible sponsorship jobs via DoctorJobsAlberta.com. Note: Your sponsor must send us a sponsorship form.
- Submit all supporting documents. Your CPSA Registration Administrator will contact you after we receive your sponsorship form.”
Source: Apply for Independent Practice, CPSA, November 2025; Practice-Ready Assessment (PRA), CPSA, November 2025; Policies, CPSA, September 2025; Approved Jurisdictions, CPSA, October 2025
- Job offer
- An approved sponsor and a job offer in a specialty deemed to be in high need in ManitobaEmployment or sponsorship opportunities are posted on Manitoba's Health Care Retention and Recruitment Office physician job board. See Manitoba jobs whose ad mentions PRA
- Practice
- Recent and relevant clinical practice experience
- Training
- Qualified to practise independently in your specialty where you trained, with completed postgraduate clinical training in the specialtyOr: Royal College certification or confirmed eligibility; member board certification or confirmed eligibility; or specialty certification from the Collège des médecins du Québec.
- Assessment
- Minimum three months: an approved assessment in your specialty, with a practice supervisor and a practice mentor
- Also required
- A certificate from the minister stating that you are required to provide medical services in a specified geographical area or practice setting
- Licence
- Provisional (specialty practice-limited) class 3.16(1)
- Steps
- Have your documents source verified by physiciansapply.ca, shared with CPSM: medical diploma, internship document, specialty postgraduate training document, and specialty certificate (if applicable).
- Confirm an employment or sponsorship opportunity in your specialty through Manitoba's Health Care Retention and Recruitment Office physician job board (Health Careers Manitoba).
- Complete an application for medical registration (AMR) through physiciansapply.ca and pay the MCC AMR fees and the CPSM documentation fee (nonrefundable). CPSM then reviews your training and practice and lists any outstanding documents.
- If CPSM requirements are met, the University of Manitoba IMG Program and Manitoba's Health Care Retention and Recruitment Office are told you are eligible for registration.
- Once the assessment is scheduled and all documentation is complete, CPSM issues a certificate of practice (licence) and a certificate of registration.
Official wording (from the college)
“This program helps international medical graduates (IMGs) who have obtained eligibility for board exams to achieve full medical licensure in Canada by securing a fellowship or job. It is for internationally trained physicians who have completed residencies and practised medicine abroad.
Expected duration: minimum three months
Provisional (specialty practice-limited) class 3.16(1)
An applicant for registration as a provisional (specialty practice-limited) member must:
- Establish that they hold:
- A medical degree granted from a nationally approved faculty of medicine, OR
- A doctor of osteopathic medicine degree from a school in the United States accredited by the American Osteopathic Association Commission on Osteopathic College Accreditation;
- Establish that they meet one of the following criteria:
- Holds the qualifications to engage independently in the practice of medicine in a specialty field of practice in a jurisdiction outside Canada in which the applicant has trained AND has satisfactorily completed postgraduate clinical training in the specialty that took place in one or more facilities that provide health care and are recognized by a national postgraduate training authority, was accredited by a national postgraduate training authority, and is approved by the registrar
- They hold Royal College of Physicians and Surgeons of Canada (RCPSC) certification or is confirmed by the Royal College to be eligible for Royal College certification
- They hold member board certification or is confirmed by a member board to be eligible for board certification
- They hold certification in a specialty field from the Collège des médecins du Québec
- Establish that they hold a certificate issued by the minister stating that the applicant is required to provide medical services in a specified geographical area or practice setting
- If applicable, establish that they have engaged in the professional practice that they intend to practise in Manitoba within the approved time period
- If applicable, provide a description of the continuing professional development activities that the applicant was required to complete as a condition of authorization to practise medicine in any jurisdiction in Canada in the three years immediately preceding the application and indicate how they met those requirements
- Establish that they have entered into a satisfactory arrangement with a practice supervisor AND have:
- Satisfactorily completed an approved assessment in their specialty field of practice, AND
- Entered into a satisfactory arrangement with a practice mentor
Key requirements
- Medical degree: An MD degree from a program acceptable to the College of Physicians & Surgeons of Manitoba (CPSM)
- Residency completion: Completing a residency program with certifying exams in your home country is generally considered a strong qualification
- Clinical experience: Recent and relevant clinical practice experience is essential
- Enrolment in the program requires an approved sponsor and a job offer in a specialty deemed to be in high need in the province of Manitoba
Application process. Do not apply until you have confirmed steps 1–3 as applications expire six months from the date they are received.
- Ensure all documents are submitted to and source verified by physiciansapply.ca. Document sharing must be enabled for College of Physicians & Surgeons of Manitoba (CPSM), and the documents include:
- Medical diploma
- Internship document
- Specialty postgraduate training document
- Specialty certificate (if applicable)
- Ensure there is an employment/sponsorship opportunity in your specialty through Manitoba's Health Care Retention and Recruitment Office physician job board.
- Complete an application for medical registration (AMR) through physiciansapply.ca. The AMR fees from the Medical Council of Canada (MCC) and the CPSM documentation fee will be required at that time. Please note that fees are nonrefundable.
- CPSM will receive your application directly from the MCC and will review your postgraduate training and practice experience to ensure requirements are met. Once the review has been completed, you will receive an email from CPSM with a list of outstanding documents. Some of the documents include, but are not limited to, the balance of documentation fee, references, evidence of good standing, and satisfactory criminal record and abuse checks.
- Should CPSM requirements be met, the University of Manitoba International Medical Graduate (IMG) Program and Manitoba's Health Care Retention and Recruitment Office will be informed of your eligibility for registration.
- If CPSM receives confirmation from the University of Manitoba IMG Program that the assessment has been scheduled and all documentation is complete, a certificate of practice (licence) and a certificate of registration will be issued.
- Documentation includes the required fees, practice undertaking, professional liability insurance, and identification (a passport and one of the following: work permit, permanent resident status or Canadian citizenship).”
Source: International Medical Graduate (IMG) Programs, University of Manitoba, April 2024
- Language
- Proof of French language proficiency, or a pass result on the Office québécois de la langue française (OQLF) examinationIf you do not plan to meet the French requirement, this route does not apply to you.
- Exam
- A pass result on the MCCQE
- Job offer
- Sponsorship with a health care institution through Recrutement Santé Québec (RSQ)
- Practice
- 12 months of competent practice in the area of medical expertise during the three years before the application
- Training
- Postgraduate training generally equivalent to Quebec’s requirements for the specialty (4 to 6 years), and a specialist’s certificate or equivalent
- Assessment
- 12 weeks, preceded by a week of observationParticipation in the ALDO-Québec educational activity is also required before the permit is issued.
- Licence
- A restrictive permit: practice only in authorized health care institutions, valid one year and renewable annuallyIt may be converted to a regular permit once specific requirements are met.
- Steps
- Pass the MCCQE.
- Obtain sponsorship with a health care institution through RSQ.
- Submit an application for medical registration and the required documents.
- The Committee on Admission to Practice (CAP) reviews the file. It meets about every 7 weeks; a decision follows within 15 business days.
- Provide proof of French proficiency or an OQLF pass result.
- Pass the 12-week assessment period.
- The CAP reviews the complete file, including the assessment, and authorizes the restrictive permit.
Official wording (from the college)
“The restrictive permit is a specific licence that limits practice to authorized health care institutions, prohibiting independent or private practice. It is valid for one year and can be renewed annually. The permit also restricts the professional acts authorized under it. Clinicians holding this permit may convert it to a “regular” permit upon meeting specific requirements. However, the permit can be revoked if the holder resigns from or is removed from the Roll of the Order, loses privileges in their health care institution, or ceases to practise.
Requirements
- Medical degree from a school listed in the World Directory of Medical Schools
- Practised competently in the area of medical expertise for which the restrictive permit application is being submitted for 12 months during the three years preceding the application
- A pass result on the Medical Council of Canada Qualifying Examination (MCCQE)
- Completed postgraduate training that is generally equivalent to Quebec’s requirements for the intended specialty (4-6 years)
- Hold a specialist’s certificate or equivalent in the relevant discipline
- Successfully completed an assessment period
- Participation in the ALDO-Québec educational activity before permit issuance
Application process
- Pass one of the examinations from the requirements section above.
- Obtain sponsorship with a health care institution through Recrutement Santé Québec (RSQ).
- Submit an application for medical registration and the required documents (documents vary, see details at the reference link below).
- Review of the complete file by the Committee on Admission to Practice (CAP) that meets about every 7 weeks. A decision will be available within 15 business days of the committee’s meeting. If an application is successful, it will move to step 5.
- Provide proof of French language proficiency or have obtained a pass result on the Office québécois de la langue française examination
- Succeed an assessment period of 12 weeks (preceded by a week of observation).
- Review of the complete file by the CAP, including result of assessment period. The committee makes the decision to authorize the issuance of the restrictive permit.
Given the length of the process (9-18 months on average) and the requirement to maintain your clinical experience, we encourage you to keep practicing as you complete the steps.”
Source: Restrictive permit, Clinician, Practice Ready Assessment (PRA), Collège des médecins du Québec, accessed September 25, 2026
This route exists in CPSNS policy, updated in 2025, but few specialists enter it. There is no intake or application window: the only way in is a job offer in your specialty from Nova Scotia Health or the IWK. Confirm with the CPSNS before you plan around it.
- Who it is for
- Specialists (other than family medicine) who completed their specialty training in an international jurisdiction
- Exam
- None listed in the CPSNS policy
- Job offer
- A job offer with Nova Scotia Health or the IWK Health Centre in your specialtyPlus funding from the Department of Health and Wellness connected to a return of service agreement.
- Training
- Specialty postgraduate training equivalent, or substantively equivalent, to the Canadian programPlus certification in your specialty where you trained.
- Practice
- Currency of practice in your specialty, as set by the CPSNS Currency of Practice Experience policyAny gap in practice must be explained.
- Not eligible
- After two or more unsuccessful attempts in Canadian practice-ready assessment programs
- Assessment
- An 8-week framework, at least 75% at other locations and at most 25% at the intended site of practiceYou are never the most responsible physician during the assessment.
- Outcome
- A defined licence with supervision, with or without further conditionsCPSNS then writes to the Canadian certifying college endorsing your eligibility for its certification exam.
- Steps
- Have all credentials source verified through physiciansapply.ca.
- Secure the job offer and the Department of Health and Wellness funding.
- CPSNS decides eligibility; the health authority selects among eligible candidates.
Official wording (from the college)
“This policy applies to all applicants for a PRA in a specialty other than family medicine who have completed their specialty training in an international jurisdiction.”
- “Applicants must have a recognized medical degree from a school listed in the World Directory of Medical Schools.”
- “Applicants must have successfully completed specialty postgraduate training in the relevant specialty that is equivalent, or substantively equivalent, to, the relevant Canadian postgraduate training program.”
- “Applicants must have certification in their specialty in the jurisdiction in which they completed their training.”
- “Applicants must meet the currency of practice requirements in their specialty as outlined in the Currency of Practice Experience policy. All candidates must provide an explanation for any gaps in practice.”
- Applicants must have “secured a job offer with Nova Scotia Health or the IWK Health Centre related to their specialty position” and “secured funding from the Department of Health and Wellness connected to a return of service agreement.”
- Candidates are ineligible “if they have had two or more unsuccessful attempts in Canadian practice ready assessment programs.”
- “All credentials must be source-verified by physiciansapply.ca.”
- “The College determines an applicant’s eligibility for a PRA and defers to the health authority regarding the selection of eligible candidates.”
Source: Pathway to Conditional Licensure for Internationally Trained Physicians via a PRA: Specialties Other Than Family Medicine, CPSNS, approved September 18 and October 17, 2025 (checked September 2026)
Alberta and Quebec name the Medical Council of Canada Qualifying Examination (MCCQE) in their requirements. Two books from the Path to Practice Series cover it: The 100-Day MCCQE Study Plan and Ethics for MCCQE and NAC.
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